ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer’s solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a “Y” connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components’ performance. Objective vs surgery Methods diameters HL20 HL 20 HL-2 pump Quadroxi Quadrox i Maquet AG Rastatt Germany, Germany , Germany) Ringers Ringer s first condition second 30 30% 1 Y “Y connector 10 mlmin ml min cannula Precannula Pre postcannula post Results mmHg 500 900 1400 2600 310 mLmin mL 12 14 respectively 600 1100 1700 2700 330 Conclusion components HL2 2 HL- 3 50 90 140 260 31 60 110 170 270 33 5 9 26 6 11 17 27

Abstract Objective: To analyze the impact of vacuum-assisted venous drainage (VAVD) on arterial pump flow in a simulated pediatric cardiopulmonary bypass circuit utilizing a centrifugal pump (CP) with an external arterial filter. Methods: The simulation circuit consisted of a Quadrox-I Pediatric oxygenator, a Rotaflow CP (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set primed with Lactated Ringer's solution and packed red blood cells. Venous line pressure, reservoir pressure, and arterial flow were measured with VAVD turned off to record baseline values. Four other conditions were tested with progressively higher vacuum pressures (-20, -40, -60, and -80 mmHg) applied to the baseline cardiotomy pressure. An arterial filter was placed into the circuit and arterial flow was measured with the purge line in both open and closed positions. These trials were repeated at set arterial flow rates of 1500, 2000, and 2500 mL/min. Results: The use of progressively higher vacuum caused a reduction in effective arterial flow from 1490±0.00 to 590±0.00, from 2020±0.01 to 1220±0.00, and from 2490±0.0 to 1830±0.01 mL/min. Effective forward flow decreased with increased levels of VAVD. Conclusion: The use of VAVD reduces arterial flow when a CP is used as the main arterial pump. The reduction in the forward arterial flow increases as the vacuum level increases. The loss of forward flow is further reduced when the arterial filter purge line is kept in the recommended open position. An independent flow probe is essential to monitor pump flow during cardiopulmonary bypass.

Resumo Objetivo: Avaliar a prevalência da polineuropatia periférica (PNP) em indivíduos obesos graus II e III com síndrome metabólica (Ob-II,III,SM) sem diabetes e buscar possíveis fatores associados. Método: Em um estudo transversal, realizado em indivíduos Ob-II,III,SM e sem diagnóstico de diabetes, o Instrumento de Screening de Michigan (MNSI) foi utilizado para avaliar a presença de PNP. Resultados: Um total de 24 de 218 pacientes Ob-II,III,SM e sem diabetes tinham PNP. Quando observamos as associações com PNP em uma análise univariada, níveis séricos de LDL-colesterol (p=0.046) estiveram significativamente associados e houve também uma tendência à associação com níveis séricos de triglicerídeos (p=0.118) e baixo HDL-colesterol (p=0.057). Em uma análise de regressão de Poisson, quando as três possíveis associações foram incluídas, baixo HDL-colesterol (p=0.047) manteve-se independentemente associado. Conclusão: Em pacientes Ob-II,III,SM, mas sem diabetes, a PNP definida pelo MNSI tem uma prevalência elevada e está associada a baixos níveis de HDL-colesterol. Para diagnóstico dessa complicação, recomenda-se realizar o exame neurológico desses pacientes.

Summary Introduction: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. Method: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. Results: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. Conclusion: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.

RESUMO Introdução: O envelhecimento traz várias modificações, entre as quais o declínio progressivo das funções fisiológicas do organismo. Tanto o treino de força quanto um programa de resistência aeróbica são importantes para evitar o declínio funcional associado à idade. Objetivo: Avaliar os efeitos de um programa de treinamento combinado de força e resistência aeróbica sobre a força de preensão manual, a massa muscular, a resistência e potência aeróbica de idosas. Métodos: Trinta e cinco mulheres (65,7 ± 6,68 anos) foram divididas em três grupos: treinamento combinado (TC; n = 15), treinamento de força (TF; n = 10) e treinamento aeróbico (TA; n = 10). Cada grupo treinou duas vezes por semana durante oito semanas, sendo que o grupo TC teve treinamento de força e aeróbico uma vez por semana. Foi utilizado o teste estatístico ANOVA e t de Student, com p ≤ 0,05. Resultados: Foi possível verificar melhoras significativas (p ≤ 0,05) dos valores de VO2pico no momento da determinação do limiar anaeróbico e aumento na força de preensão manual em todos os grupos pesquisados, assim como dos valores de massa muscular do vasto lateral (p ≤ 0,05). Conclusão: Os resultados sugerem que um programa de treinamento combinado é tão eficaz para ocasionar aumentos de massa muscular, potência e resistência aeróbica de idosas, quanto o treinamento de resistência aeróbica ou força realizado duas vezes por semana, organizados separadamente.

ABSTRACT Introduction: Aging brings several modifications, including the progressive decline of physiological functions of the body. Both strength training and an aerobic endurance program are important to avoid functional decline associated with age. Objective: To evaluate the effects of a combined training program of strength and endurance on handgrip strength, muscle mass, endurance and aerobic power of elderly women. Methods: Thirty-five women (65.7±6.68 years) were divided into three groups: combined training (CT, n=15), strength training (ST, n=10) and aerobic training (AT, n=10). Each group trained twice a week during eight weeks, and the CT group had strength and aerobic training once a week. We used the ANOVA statistical test and the Student's t test, with p≤0.05. Results: It was possible to observe significant improvements (p≤0.05) for VO2max values when determining the anaerobic threshold and increase grip strength in all groups studied, as well as the muscle mass of the vastus lateralis (p≤0.05). Conclusion: The results suggest that a combined training program is as much effective to cause increases of muscle mass, strength, and aerobic endurance in elderly women as aerobic endurance or strength training performed twice a week, arranged separately.

RESUMEN Introducción: El envejecimiento trae diversas modificaciones, incluyendo la disminución progresiva de las funciones fisiológicas del organismo. Tanto el entrenamiento de fuerza como un programa de resistencia aeróbica son importantes para prevenir el deterioro funcional asociado a la edad. Objetivo: Evaluar los efectos de un programa de entrenamiento combinado de fuerza y resistencia aeróbica en la fuerza de prensión manual, la masa muscular, la fuerza y la potencia aeróbica de mujeres mayores. Métodos: Treinta y cinco mujeres (65,7 ± 6,68 años) se dividieron en tres grupos: entrenamiento combinado (EC, n = 15), entrenamiento de fuerza (EF, n = 10) y entrenamiento aeróbico (EA, n = 10). Cada grupo ha entrenado dos veces por semana durante ocho semanas, y el grupo de EC ha tenido entrenamiento de fuerza y aeróbico una vez a la semana. Se utilizó el ANOVA y la prueba t de Student, con p ≤ 0,05. Resultados: Fue posible observar mejoras significativas (p ≤ 0,05) de los valores de VO2pico en el momento de la determinación del umbral anaeróbico y el aumento de la fuerza de prensión manual en todos los grupos estudiados, así como los valores de masa muscular del vasto lateral (p ≤ 0,05). Conclusión: Los resultados sugieren que un programa de entrenamiento combinado es tan efectivo para ocasionar aumento de la masa muscular, la fuerza y resistencia aeróbica de mujeres mayores, como el entrenamiento de resistencia aeróbica o fuerza realizado dos veces por semana, dispuestos por separado.